The history of alcohol
Alcohol has long been a mainstay of the population’s diet but as its impact on health has become more recognised, so too has the need for policy to protect people from harm. Alcohol policy has historically focused on strategic harm reduction by, for example, focussing on limiting disorderly behaviour. However, in more recent years the effect of alcohol on our health has become the driving force for regulation. Legislation to restrict alcohol has varied in its focus, from restricting the sale of the product, to premises’ opening hours and licensing of the seller. Each approach has been met with varying levels of success.
One of the earliest known legislative actions on alcohol was during the ‘Gin Craze’ which spanned across the late 17th century and early 18th century. Due to political and religious conflict between Great Britain and France, the Government passed a range of legislation to restrict French brandy imports and increase British gin production. These proved successful in their aims and the consumption of gin amongst the population increased dramatically. The average person was drinking six gallons of gin per year. Gin provided an escape for the 18th Century poor, and the insatiable demand for the liquor was soon linked to crime, poverty and a soaring death rate. The drink became known as ‘Mother’s Ruin’ as mothers began to neglect their children in favour of the drink, and between 1730 and 1749, 75% of children born in London died under the age of 5.[1][2][3] Between 1729 and 1751, eight Gin Acts were introduced in an attempt to restrict the availability of the alcohol and curb this “social evil”. However, this did not curtail the widespread alcoholism, but instead forced the distillation and consumption of gin underground, creating a black market for bootleg gin.[4] The Gin Act 1751, commonly known as the Tippling Act, was the penultimate Act in a series of eight, which succeeded in reducing the consumption of the alcohol, with the reason for its passing stated as: ‘‘…the immoderate drinking of distilled Spirituous Liquors by Persons of the meanest and lowest sort, hath of late years increased, to the great Detriment of the Health and Morals of the common People’.
Much like today, social determinants of health, such as socioeconomic status, affected people’s consumption of alcohol, and the cheapness and widespread availability of gin meant that alcoholism was common amongst the working classes. The Sale of Spirits Act 1750, commonly known as the Gin Act 1751, prohibited gin distillers from selling to unlicensed merchants and the ‘Gin Craze’ was eventually brought under control.
In the 1830s, social reformers made the link between alcohol and issues such as poverty, child neglect and economic decline and, in response to the high levels of alcohol consumption in society, a temperance movement began.
The first organisation to promote temperance in Britain, founded in Scotland, was the Glasgow and West of Scotland Temperance Society. Soon, organisations across the UK began to establish themselves, with a stricter form of temperance developing, called teetotalism, which promoted complete abstinence from alcohol.
During the 19th century, licensing laws began to focus on restricting the opening hours of premises. In Wales, the Sunday Closing (Wales) Act 1881 banned the sale of alcohol on a Sunday. It was one of a number of Licensing Acts across the UK introduced between 1828 and 1886 which introduced various regulations and offences relating to alcohol, particularly the licensing of premises.
Nearly a hundred years later, the Licensing Act 1972 stated that licensing hours could be determined by local authorities and gave boroughs the option of becoming completely ‘dry’. Since then, various iterations of the Licensing Act have been introduced, affecting both the sale and supply of intoxicating liquor and regarding licensed premises. In England and Wales, the alcohol licensing system underwent a major overhaul with the 2003 Licensing Act. The Act moved responsibility from local magistrates to local councils, introducing a more permissive system, which created ‘responsible authorities’ and ‘licensing objectives’.
Four licensing objectives exist which seek to protect communities and local populations from harm and responsible authorities have a duty to challenge applications for licenses which threaten to undermine any one of them. Directors of Public Health in England are included in the Act as a ‘responsible authority’, as their role is to promote the health and wellbeing of the populations they serve. The Scottish Licensing Act established a similar system but went further by including an additional licensing objective of ‘protecting and improving public health’. ADPH are now advocating for the same recognition of the importance of public health to be replicated in the England/Wales Act.
One landmark piece of legislation affecting alcohol policy was the Road Safety Act 1967, which made it an offence to operate a vehicle with a blood alcohol concentration of over 80mg of alcohol per 100ml of blood. Since 1979, when records began, the number of drink driving deaths per year has fallen by 87% – from 1640 to 220 people in 2020[5]
Minimum Unit Pricing (MUP) is another, more recent, example of how policy interventions can improve population health. Implemented in Scotland in 2018 and in Wales in 2020, MUP sets a minimum price of 50p per unit of alcohol sold, meaning the more alcohol a drink contains, the higher the price. A study released this year associated MUP in Scotland with a 13% fall in deaths from alcohol consumption.[6] The greatest reductions in deaths were seen in people living in the most socioeconomically deprived 40% of Scotland providing clear evidence of the benefit alcohol control can have on reducing harm and protecting vulnerable communities. In our 2019 survey of UK DsPH, 83% of respondents said that they strongly supported the introduction of a minimum unit price of 50p in England.
Excise duties are indirect taxes placed on the sale of products, such as alcohol, and they exist to discourage the purchase of goods. The duty escalator – the adjustment of duty rates each year in line with inflation – was reversed by the Government in 2013. Alcohol-specific deaths levelled out when the alcohol duty escalator was in place between 2008 and 2013.[7] Therefore, ADPH supports calls for the Government to reintroduce the tax escalator on alcohol at 2% per annum ahead of inflation.
Commercial determinants of health (CDOH) play a major role in people’s exposure to and consumption of alcohol. CDOH are private sector activities which affect people’s health directly and indirectly, positively or negatively. In the alcohol industry, these activities include framing alcohol and its place in our society as a positive, relaxing and sociable activity; creating highly targeted marketing campaigns to show alcohol as an attractive, acceptable product, particularly to children and young people; and influencing legal and political processes to prevent stricter legislation being introduced.
Policy can and should be introduced to tackle the burden of harm inflicted on populations by unhealthy commodity industries and the Alcohol Health Alliance UK (AHA) brings together organisations, including ADPH, to promote evidence-based policies that would, if implemented, reduce the harm caused by alcohol.
Societal harms associated with alcohol consumption have, throughout history, been an argument for legislation to be placed around the sale and supply of alcohol. In more recent years, with increasing numbers of people becoming ill as a result of alcohol consumption, health has become a vital component of these arguments.[8] There is still space for alcohol policy to develop across the four nations to reduce alcohol harm and ensure that those most vulnerable in our society are protected – it is essential that we build on historical progress to protect future generations.
[1] https://www.uvic.ca/research/centres/cisur/assets/docs/iminds/drug-gin-craze-hdt.pdf
[2] https://www.bl.uk/learning/timeline/item105855.html
[3] https://www.diffordsguide.com/g/1108/gin/history-of-gin-1728-1794
[4] https://archives.blog.parliament.uk/2017/05/30/the-tippling-act-and-londons-300-year-love-of-gin/
[5] https://www.gov.uk/government/statistics/reported-road-casualties-in-great-britain-final-estimates-involving-illegal-alcohol-levels-2020/reported-road-casualties-in-great-britain-final-estimates-involving-illegal-alcohol-levels-2020
[6] https://www.bmj.com/content/380/bmj.p672
[7] https://www.ias.org.uk/uploads/pdf/IAS%20reports/rp38102019.pdf
[8] https://www.ias.org.uk/2023/01/30/what-happened-with-uk-alcohol-consumption-and-harm-in-2022/